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Issue #186 - December 7, 2011
AAPC EdgeBlast

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5010 Enforcement Delay Set

The Centers for Medicare & Medicaid Services (CMS) Office of E-health Standards and Services (OESS) recently announced that it's loosening its ASC X12 Version 5010 standards compliance enforcement with a 90-day discretion period for all Health Insurance Portability and Accountability Act (HIPAA) covered entities. It has come just in time before the compliance Jan. 1, 2012 deadline; however, is it enough time to meet compliance expectations?

CMS said it will initiate enforcement on office-based physicians, health insurance plans, and claims clearinghouses starting March 31, 2012. CMS made this decision based on industry feedback from organizations and their trading partners who aren't ready to finalize system upgrades to 5010 standards.

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Dec. 21 Nat'l Provider Call to Discuss Payment, Risk

The Centers for Medicare & Medicaid Services (CMS) will hold a National Provider Call to discuss changes to the Medicare Physician Fee Schedule's (MPFS) Physician Feedback Program and the value-based payment modifier (Value Modifier) for calendar year 2012.

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AAPC Requests Uniform Standards and Edits at Hearing

On Nov. 17 and 18, the National Committee for Vital Health Statistics (NCVHS) held hearings on the need for uniform standards and edits across the industry. AAPC's Rhonda Buckholtz, CPC, CPMA, CPC-I, CGSC, COBGC, CPEDC, CENTC, vice president of ICD-10 education, offered testimony on the daily frustrations currently encountered by members. Here is some of that testimony:

"Currently a sampling survey of AAPC members indicated that on average most practices contract with no less than 18 health plans and some upwards of 80+. As we are all aware, no two plans are alike and even within each plan itself the different family of offerings make the frustration of not having consistent guidelines and edits an administrative burden most practices simply can't afford. There are many items that go into setting up practice management systems to handle edits correctly, but simply transitioning to electronic does not solve all the burdens."

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AMA Vigorously Opposes 2013 ICD-10 Implementation

During its 65th Interim Meeting in New Orleans, the American Medical Association's (AMA's) House of Delegates formally resolved to "vigorously work to stop the implementation of ICD-10 and to reduce its unnecessary and significant burdens on the practice of medicine." The AMA cited cost as the most significant of those burdens.

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Berwick Out, Tavenner In at CMS

Acting Centers for Medicare & Medicaid Services (CMS) Administrator Donald Berwick, MD, MPP, resigned Dec. 2 after failing to garner support for appointment by Congress. Marilyn Tavenner, RN, the associate administrator of CMS, will take his place. She will still need a favorable vote from Congress before becoming the full-fledged administrator of the agency.

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OIG Tells Congress Over $5 Billion Recovered

In its Semiannual Report to Congress, the Office of Inspector General (OIG) announced 2011 exclusions of 2,662 individuals and entities from participation in federal health care programs, and expected recoveries of approximately $5.2 billion in audit and investigative receivables.

The OIG also reported 723 criminal actions against individuals or entities that engaged in crimes against U.S. Department of Health & Human Services (HHS) programs and 382 civil actions, which included false claims and unjust-enrichment lawsuits filed in federal district court, civil monetary penalties (CMP) settlements, and administrative recoveries related to provider self-disclosure matters.

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Round 2: Medicare Calls DME Suppliers to the Ring

The Centers for Medicare & Medicaid Services (CMS) released on Nov. 30 a detailed timeline for Round 2 of the Competitive Bidding Program for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS).

Under the program DMEPOS suppliers compete to become Medicare contract suppliers by submitting bids to provide certain items in competitive bidding areas (CBAs).

The first phase of the program was implemented on Jan. 1, 2011 for nine product categories in nine areas of the country. CMS opened up registration for the second phase on Dec. 5 and bidding will begin in late January 2012.

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Coding Tips

Medicare Telehealth Services Expanded for 2012
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"Always Therapy" Code Added to 2012 Therapy Code List
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Medicare Adds Obesity Screening and Counseling Coverage
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Medical News

AAP Recommends HIV Testing for Teens and Young Adults
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RACs Recoup, Hospitals Appeal with Success
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New Demonstration Projects Crack Down on Improper Payments
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HHS Releases Seed $ for Quality Innovations
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Featured Items
5010 Delayed
Nat'l Provider Call
Uniform Standards, Edits
AMA Opposes 2013 ICD-10
Tavenner In at CMS
OIG: Over $5B Recovered
CMS Competitive Bidding
Coding Tips
Medical News
Coding Job Links


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